Articles: emergency-services.
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Multicenter Study
Variation in management of recent-onset atrial fibrillation and flutter among academic hospital emergency departments.
Although recent-onset atrial fibrillation and flutter are common arrhythmias managed in the emergency department (ED), there is insufficient evidence to help physicians choose between 2 competing treatment strategies, rate control and rhythm control. We seek to evaluate variation in ED management practices for recent-onset atrial fibrillation and flutter patients at multiple Canadian sites and to determine whether hospital site was an independent predictor of attempted cardioversion. ⋯ We demonstrated a high degree of variation in management approaches for recent-onset atrial fibrillation and flutter patients treated in academic hospital EDs. Individual hospital site, age, previous cardioversion, and associated heart failure were independent predictors for the use of rhythm control.
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Ann. Allergy Asthma Immunol. · Jan 2011
Multicenter StudyPredictors of hospital admission for food-related allergic reactions that present to the emergency department.
guidelines do not provide specific hospitalization criteria for patients presenting to the emergency department (ED) with food-related allergic reactions. ⋯ most patients presenting to the ED with food-related allergic reactions are discharged. Several patient factors were independently associated with hospital admission in ED patients with food-related allergic reactions.
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BMC emergency medicine · Jan 2011
Multicenter StudyBe careful with triage in emergency departments: interobserver agreement on 1,578 patients in France.
For several decades, emergency departments (EDs) utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.e. which could have been dealt with by general practitioner. The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups based on following explicit criteria: age, medical status, type of referral to the ED, investigations performed in the ED, and the discharge from the ED. ⋯ The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used to determine treatment priority, disagreement might not matter because all patients in the ED are seen and treated. But using assessments as the basis for refusal of care to potential nonurgent patients raises legal, ethical, and safety issues. Managed care organizations should be cautious when applying such criteria to restrict access to EDs.
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World journal of surgery · Jan 2011
Multicenter StudyOutcomes from prehospital cardiac arrest in blunt trauma patients.
There are few strategies for treating patients who have suffered cardiopulmonary arrest due to blunt trauma (BT-CPA). The aim of this population-based case series observational study was to clarify the outcome of BT-CPA patients treated with a standardized strategy that included an emergency department thoracotomy (EDT) under an emergency medical service (EMS) system with a rapid transportation system. ⋯ In BT-CPA patients, a 20-min resuscitation effort and termination of the effort are thought to be relevant. The initial rhythm is not a prognostic indicator. We believe that the decision on whether to undertake aggressive resuscitation efforts should be made on a case-by-case basis.
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Pediatric emergency care · Dec 2010
Multicenter StudyPhysician practice variation in the pediatric emergency department and its impact on resource use and quality of care.
To evaluate variation in case-mix adjusted resource use among pediatric emergency department (ED) physicians and its correlation with ED length of stay (LOS) and return rates. ⋯ Significant variation exists in physician use of common ED resources. Higher resource use was associated with increased LOS but did not reduce return to ED. Practice variation such as this may represent an opportunity to improve health care quality and decrease costs.